Organization
INNER PATH WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSICA AYESHA RODRIGUES SUNDRAM LCSW (OWNER)
(505) 750-3605
Entity
Organization
Contact information
Practice address
200 ROSEMONT AVE NE APT C, ALBUQUERQUE, NM 87102-1599
(505) 750-3605
(505) 340-3941
Mailing address
300 MENAUL BLVD NW STE A PMB 468, ALBUQUERQUE, NM 87107-9951
(505) 750-3605
(505) 340-3941
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09020
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59605251
—
NM
Enumeration date
09/03/2017
Last updated
07/20/2021
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